Senior Clinical Coding Registered Nurse – Clearwater, FL

The Sr. Clinical Coding Nurse Consultant will drive consistent, efficient processes and share best practices in a collaborative effort with Providers and Market Team, designed to facilitate achievement of goals set for HCC Ratio, HCC Covered Ratio, and HCC Percent Covered. The Sr. Clinical Coding Nurse Consultant will drive Risk Adjustment improvement initiatives, develop recommendations for Risk Adjustment remediation plans and create tools and databases to capture relevant data for assigned markets to achieve corporate and market specific Risk Adjustment goals and initiatives. This position will work collaboratively with each regional / market team and their leadership in a matrix relationship. This position will provide direction and guidance to Medical Coding Analysts, as well as cross functional team members within their respective Markets pertaining to Risk Adjustment.

This is an office base position near Sunforest Dr., Tampa, FL. This position requires traveling around the Clearwater/Saint Petersburg FL area including counties supporting Clinics, Offices, Educations Centers, etc. Mileage Reimbursement will be provided based on the department guidelines. CPC Allowance. New Hire onboarding and training will be 8 – 12 weeks at the office.  After training is complete, 1-3 days at the office as deemed by the business.
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
 
Required Qualifications:

• Bachelor’s degree in Nursing (Associate’s Degree or Nursing Diploma from accredited nursing school with 2+ years of additional experience may be substituted in lieu of a Bachelor’s degree) and current RN license
• Registered Nurse license in good standing
• CPC certification or proof that certification has been obtained within 9 months from the American Academy of Professional Coders
• 5+ years of associated business experience with health care industry
• 1+ years of ICD-9, ICD10 coding experience
• Professional experience persuading changes in behavior
• Knowledge of CMS HCC Model and Guidelines along with ICD 10 guidelines
• Solid knowledge of the Medicare market, products and competitors
• Knowledge base of clinical standards of care and preventative health measures
• Ability and willingness to travel (locally and non-locally) as determined by business needs

 
Preferred Qualifications:

• Undergraduate degree
• Experience in managed care working with network and provider relations
• Additional Medical chart review experience
• Medical/clinical background
• Moderate to advanced skills with MS Office suite, including Excel and PowerPoint
• Solid presentation skills and relationship building skills with clinical / non-clinical personnel
• Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
• Ability to solve process problems crossing multiple functional areas and business units
• Solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
• Good business acumen, especially as it relates to Medicare

 
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.